Heart and Vessels

, Volume 32, Issue 9, pp 1123–1129 | Cite as

Energy dynamics of the intraventricular vortex after mitral valve surgery

  • Kouki Nakashima
  • Keiichi ItataniEmail author
  • Tadashi Kitamura
  • Norihiko Oka
  • Tetsuya Horai
  • Shohei Miyazaki
  • Masaki Nie
  • Kagami Miyaji
Original Article


Mitral valve morphology after mitral valve surgery affects postoperative intraventricular flow patterns and long-term cardiac performance. We visualized ventricular flow by echocardiography vector flow mapping (VFM) to reveal the impact of different mitral valve procedures. Eleven cases of mechanical mitral valve replacement (nine in the anti-anatomical and two in the anatomical position), three bioprosthetic mitral valve replacements, and four mitral valve repairs were evaluated. The mean age at the procedure was 57.4 ± 17.8 year, and the echocardiography VFM in the apical long-axis view was performed 119.9 ± 126.7 months later. Flow energy loss (EL), kinetic pressure (KP), and the flow energy efficiency ratio (EL/KP) were measured. The cases with MVR in the anatomical position and with valve repair had normal vortex directionality (“Clockwise”; N = 6), whereas those with MVR in the anti-anatomical position and with a bioprosthetic mitral valve had the vortex in the opposite direction (“Counterclockwise”; N = 12). During diastole, vortex direction had no effect on EL (“Clockwise”: 0.080 ± 0.025 W/m; “Counterclockwise”: 0.083 ± 0.048 W/m; P = 0.31) or KP (“Clockwise”: 0.117 ± 0.021 N; “Counterclockwise”: 0.099 ± 0.057 N; P = 0.023). However, during systole, the EL/KP ratio was significantly higher in the “Counterclockwise” vortex than that in the “Clockwise” vortex (1.056 ± 0.463 vs. 0.617 ± 0.158; P = 0.009). MVP and MVR with a mechanical valve in the anatomical position preserve the physiological vortex, whereas MVR with a mechanical valve in the anti-anatomical position and a bioprosthetic mitral valve generate inefficient vortex flow patterns, resulting in a potential increase in excessive cardiac workload.


Vector flow mapping (VFM) Mitral valve surgery Flow energy loss 



Computed tomography


Energy loss


Kinetic pressure


Left ventricle


Left ventricular diastolic dimension


Left ventricular systolic dimension


Left ventricular ejection fraction


Mitral regurgitation


Mitral stenosis


Mitral valve plasty


Mitral valve replacement


Magnetic resonance imaging


Particle imaging velocimetry


Transthoracic echocardiography


Vector flow mapping


Compliance with ethical standards

Conflict of interest

Dr. Keiichi Itatani was an endowed chair of Kitasato University, financially supported by Hitachi-Aloka Medical Co., Ltd. (Oct 2012–Jun 2015). He is also an endowed chair of Kyoto Prefectural University of Medicine, financially supported by Medtronic Japan Inc. (Apr 2016-present). He has a stock option of Cardio Flow Design Inc. The other authors have no conflicts of interest.


  1. 1.
    Sengupta PP, Pedrizzetti G, Kilner PJ, Kheradvar A, Ebbers T, Tonti G, Fraster AG, Narula J (2012) Emerging trends in CV flow visualization. JACC Cardiovasc Imaging 5: 305–316CrossRefPubMedGoogle Scholar
  2. 2.
    Hong GR, Kim M, Pedrissetti G, Vannan MA (2013) Current clinical application of intracradiac flow analysis using echocardiography. J Cardiovasc Ultrasound 21:155–162CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Sughimoto K, Shimamura Y, Tezuka C, Tsubota KI, Liu H, Okumura K, Masuda Y, Haneishi H (2016) Effects of arterial blood flow on walls of the abdominal aorta: distributions of wall shear stress and oscillatory shear index determined by phase-contrast magnetic resonance imaging. Heart Vessels 31:1168–1175CrossRefPubMedGoogle Scholar
  4. 4.
    Koyama S, Kitamura T, Itatani K, Yamamoto T, Miyazaki S, Oka N, Nakashima K, Horai T, Ono M, Miyaji K (2016) Impact of top end anastomosis design on patency and flow stability in coronary artery bypass grafting. Heart Vessels 31:643–648CrossRefPubMedGoogle Scholar
  5. 5.
    Faludi R, Szulik M, D’hooge J, Herijgers P, Rademakers F, Pedrizzetti G, Voigt JU (2010) Left ventricular flow patterns in healthy subjects and patients with prosthetic mitral valves: an in vivo study using echocardiographic particle image velocimetry. J Thorac Cardiovasc Surg 139:1501–1510CrossRefGoogle Scholar
  6. 6.
    Itatani K (2014) When the blood flow becomes bright. Intraventricular flow patterns: from normality to pathology. Eur Heart J 35:747–752PubMedGoogle Scholar
  7. 7.
    Itatani K, Okata T, Uejima T, Tanaka T, Ono M, Miyaji K, Takenaka K (2013) Intraventricular flow velocity vector visualization based on the continuity equation and measurements of vorticity and wall shear stress. Jpn J Appl Phys 52:07HF16CrossRefGoogle Scholar
  8. 8.
    Honda T, Itatani K, Miyaji K, Ishii M (2014) Assessment of the vortex flow in the post-stenotic dilatation above the pulmonary valve stenosis in an infant using echocardiography vector flow mapping. Eur Heart J 35:306CrossRefGoogle Scholar
  9. 9.
    Kim HB, Hertzberg JR, Shandas R (2004) Echo PIV for flow field measurements in vivo. Biomed Sci Instrum 40:357–363PubMedGoogle Scholar
  10. 10.
    Prinz C, Faludi R, Walker A, Amzulescu M, Gao H, Uejima T, Fraser AG, Voigt JU (2012) Can echocardiographic particle image velocimetry correctly detect motion patterns as they occur in blood inside heart chambers? A validation study using moving phantoms. Cardiovasc Ultrasound 10:24CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Ohtsuki S, Tanaka M (2006) The flow velocity distribution from Doppler information on a plane in three-dimensional flow. J Vis 9:69–82CrossRefGoogle Scholar
  12. 12.
    Garcia D, Del Alamo JC, Tanne D, Yotti R, Cortina C, Bertrand E, Antoranz JC, Perez-David E, Rieu R, Fernandez-Aviles F, Bermejo J (2010) Two-dimensional intraventricular flow mapping by distal processing conventional color-Doppler echocardiography images. IEEE Trans Med Imaging 29:1701–1713CrossRefGoogle Scholar
  13. 13.
    Föll D, Taeger S, Bode C, Jung B, Markl M (2013) Age, gender, blood pressure, and ventricular geometry influence normal 3D blood flow characteristics in the left heart. Eur Heart J Cardiovasc Imaging 14:366–373CrossRefPubMedGoogle Scholar
  14. 14.
    Mangual JO, De Luca A, Kraigher-Krainer E, Toncelli L, Shah A, Solomon S, Galanti G, Domenichini F, Pedrizzetti G (2013) Comparative numerical study on left ventricular fluid dynamics after dilated cardiomyopathy. J Biomech 46:1611–1617CrossRefPubMedGoogle Scholar
  15. 15.
    Fukuda N, Itatani K, Kimura K, Ebihara A, Negishi K, Uno K, Miyaji K, Kurabayashi M, Takenaka K (2014) Prolonged vortex formation during the ejection period in the left ventricle with low ejection fraction: a study by vector flow mapping. J Med Ultrasonic 41:301–310CrossRefGoogle Scholar
  16. 16.
    Mangual JO, Domenichini F, Pedrizzetti G (2012) Describing the highly three dimensional Right Ventricle flow. Ann Biomed Eng 40:1790–1801CrossRefPubMedGoogle Scholar
  17. 17.
    Akutsu T, Imai R, Deguchi Y (2005) Effect of the flow field of mechanical bileaflet mitral prostheses on valve closing. J Artif Organ 8:161–170CrossRefGoogle Scholar
  18. 18.
    Hong GR, PedrizzettiG, Tonti G, Li P, Wei Z, Kim JK, Baweja A, Liu S, Chung N, Houle H, Narula J, Vannan MA (2008) Characterization and quantification of vortex flow in the human left ventricle by contrast echocardiography using vector particle image velocimetry. JACC Cardiovasc Imaging 1:705–717CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Japan 2017

Authors and Affiliations

  • Kouki Nakashima
    • 1
    • 2
    • 3
  • Keiichi Itatani
    • 4
    Email author
  • Tadashi Kitamura
    • 3
  • Norihiko Oka
    • 3
  • Tetsuya Horai
    • 3
  • Shohei Miyazaki
    • 2
  • Masaki Nie
    • 1
    • 3
  • Kagami Miyaji
    • 2
    • 3
  1. 1.Department of Cardiovascular SurgeryEbina General HospitalEbinaJapan
  2. 2.Department of Hemodynamic AnalysisKitasato University School of MedicineSagamiharaJapan
  3. 3.Department of Cardiovascular SurgeryKitasato University School of MedicineSagamiharaJapan
  4. 4.Department of Cardiovascular SurgeryKyoto Prefectual University of MedicineKyotoJapan

Personalised recommendations